Claims Processing Specialist - Post Bill
The primary job responsibility of the Claims Processing Specialist is to follow up on Medicaid/AHCCCS, Medicare, Commercial Insurance and Contracted claims directly with the payers.
- The Claims Processing Specialist may be assigned one or more duties. These duties may include, but are not limited to, the following:
- Verify submitted claims forms is complete and accurate, updating system information as needed.
- Superior data entry proficiency
- Process claims according to guidelines while identifying claims requiring exception handling.
- Prioritize and coordinate influx of daily workload for claims processing, returned mail, and out-going correspondence and emails to assure required turnaround time us met.
- Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
- Effectively work through denial/appeal process and meeting filing requirements.
- Work with department manager to determine special projects on an as needed basis.
- Participate in documentation feedback information for the operations.
- Obtain continuous knowledge of CMS regulations.
- Make decisions and take appropriate actions based on sound reasoning and judgment.
- Contribute ideas; strive to enhance team effectiveness and support decisions made by the team.
- Plan and perform work systematically and efficiently.
- Carry out instructions, maintain a positive attitude, and support company policies/procedures.
- Punctuality and availability for workload.
- Comply with HIPAA guidelines
- Attend and maintain all required Falck USA training
- Maintain knowledge of functional area and company policies and procedures
The Claims Processing Specialist may be assigned one or more additional duties. These duties may include, but are not limited to, the following:
- Assist with training new employees
- Providing feedback to management concerning possible problems or areas of improvement
- Making recommendations to implement improved processes.
- Performing other duties as assigned by management.